BEUDAMED
    FDA Adverse Event Injury Summary report: N

    R3

    MDR report key: 2132893 · Received June 17, 2011

    Report

    Report Number
    1020279-2011-00202
    Event Type
    Injury
    Date Received
    June 17, 2011
    Date of Event
    April 7, 2011
    Report Date
    June 17, 2011
    Manufacturer
    SMITH AND NEPHEW, INC.
    Product Code
    JDG
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    OH, US
    Reporter Occupation
    HEALTH PROFESSIONAL

    Narratives

    Additional Manufacturer Narrative · 1

    AFTER FURTHER INVESTIGATION, IT WAS DETERMINED THE PRODUCT INITIALLY REPORTED WAS NOT A SMITH AND NEPHEW PRODUCT.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT A REVISION SURGERY WAS PERFORMED

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 R3 ACETABULAR CUP JDG SMITH AND NEPHEW, INC.

    Patients

    Seq Age Sex Outcome Treatment
    1 50 YR Hospitalization